Abstract
Much of what we know about home care aides’ work is well documented in this book: wages are low, benefits are few, turnover is high, and the work is physically dangerous, emotionally difficult, and frequently viewed as demeaning. So why do some people remain in home care work? How do they find meaning and reward in their work?
The long-term care industry is one of the fastest growing sectors for new jobs and will continue on that trajectory for decades as baby boomers age. To meet that demand what employment policy lessons can we learn from those who commit to this work despite the grim working conditions?
The Caring Self explores how aides’ “emotional labor” shapes their self-identity. Through interviews and observations of 33 home care aides in two states, the author collected a rich set of anecdotal evidence to support her argument that these workers “actively construct and narrate a sense of self, what I call the caring self, by drawing directly (and strategically) on the relational dimensions of their work” (p. 12). Stacey qualifies her conclusions, acknowledging that she used self-selected participants, but notes that “field methods that include observation and in-depth interviewing lend themselves to ‘involvement and enmeshment’ rather than ‘objectivity and distance.’”
Stacey does not endorse a “low road” strategy for employment in this sector. She recognizes the inequalities faced by this predominantly female and minority workforce. She cites two reasons to study aides’ subjective accounts of work and self. First, “to understand how inequalities of labor sustain over time, we must … understand how workers adapt to or challenge the limits of opportunity.” Second, policy makers seeking to create a qualified home care workforce need “to understand what material and nonmaterial rewards foster recruitment and retention” (p. 90).
While rewards are scarce, there are some positives to home care work—autonomy and strong emotional ties with clients. Aides work alone with low levels of supervision and have a wide latitude to structure work tasks.
In Stacey’s view, even more rewarding is the emotional relationship with the client. She identifies three relational dimensions that aides say create a positive sense of self on the job and reduces burnout: caring as a natural ability, providing care as a service to others, and a belief that their care is better than that provided by others. Stacey argues that only by understanding aides’ emotional commitments to clients can we appreciate which dimensions of caregiver-client interaction deplete or foster job satisfaction, a positive sense of self, and dignity.
The penultimate chapter presents a brief discussion of union organizing efforts in home care. Dispersed work settings, lack of a collective identity, ambiguity over who is the employer, and legal impediments to collective bargaining are all characteristics of this work that make unionization difficult. Based on the caregivers’ mixed opinions about unions, Stacey recommends placing the caregiver-client relationship at the center of organizing efforts.
One issue not addressed by Stacey is the potential tension between aides and clients as they each seek to create a sense of self in their relationship. The “caring self” is critical to many aides’ identity, while many clients value self-determination. Aides see themselves providing care while their clients see themselves receiving support. The distinction between care and support is more than semantic: each partner seeks a relationship that defines their own self-dignity.
Stacey effectively supports her conclusions with the stories and words of the aides themselves. Unfortunately I did find that there is substantial repetition of points made.
I would recommend this book for students of work sociology and labor studies and for those active in the long-term care field, both as an example of qualitative research and for the insights it provides about a much neglected workforce. This book would benefit policy makers in fashioning solutions to the accelerating need to provide quality support/care for long-term care consumers.